DSM-5 in New Scientist: Psychiatry’s new diagnostic bible is creating headaches for doctors and patients alike

DSM-5 in New Scientist: “Psychiatry’s new diagnostic bible is creating headaches for doctors and patients alike”

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A reminder that this third and final stakeholder review and comment period is scheduled to close on June 15.

On May 17, APA added the following statement to the home page of the DSM-5 Development site.

APA Position Statement on DSM-5 Draft Diagnostic Criteria

The official position of the APA on draft DSM-5 diagnostic criteria is that they are not to be used for clinical or billing purposes under any circumstances. They are published on the http://www.dsm5.org Web site to obtain feedback on these preliminary DSM-5 Task Force proposals from mental health professionals, patients, and the general public. They have not received official reviews or approval by the APA Board of Trustees and will not be available for clinical use or billing purposes until May 2013.

Two articles in this week’s online and print editions of New Scientist.

The first report, by Peter Aldhous, quotes Allen Frances, MD, who had chaired the development of the DSM-IV; APA research director and DSM-5 Task Force Vice Chair, Darrel Regier, and Dr Dayle Jones who is tracking DSM-5 for the American Counseling Association, on DSM-5 field trial kappa results and the relegation of Attenuated psychosis syndrome and Mixed anxiety/depression to the DSM-5 appendix.

This article is behind a paywall or a subscription to the print edition.

New Scientist 19 May 2012

Page 6 print edition

THIS WEEK/MENTAL HEALTH

Psychiatry’s new diagnostic bible is creating headaches for doctors and patients alike

Online title Trials highlight worrying flaws in psychiatry ‘bible’

Peter Aldhous

Diagnosis: uncertain

HOW reliable is reliable enough?

The second article, “OPINION ‘Label jars, not people”, by James Davies, is accessible on the New Scientist website without payment or print edition subscription.

New Scientist 19 May 2012

Page 7 print edition

OPINION | James Davies

James Davies is a senior lecturer in social anthropology and psychotherapy at the University of Roehampton, London

‘Label jars, not people’

“LABEL jars, not people” and “stop medicalising the normal symptoms of life” read placards, as hundreds of protesters – including former patients, academics and doctors – gathered to lobby the American Psychiatric Association’s (APA) annual meeting.

The demonstration aimed to highlight the harm the protesters believe psychiatry is perpetrating in the name of healing. One concern is that while psychiatric medications are more widely prescribed than almost any drugs in history, they often don’t work well and have debilitating side effects. Psychiatry also professes to respect human rights, while regularly treating people against their will. Finally, psychiatry keeps expanding its list of disorders without solid scientific justification…

Read full article

Cosgrove, Sheldon: 69% of DSM-5 task force members report pharmaceutical industry ties

Cosgrove, Sheldon: 69% of DSM-5 task force members report pharmaceutical industry ties – review identifies potential COIs

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“Board of Trustee Principles” here:
http://www.dsm5.org/about/Pages/BoardofTrusteePrinciples.aspx

“DSM-V Task Force and Work Group Acceptance Form” here:
Approved by BOT July2006 Amended and Approved by BOT October 2007
http://www.dsm5.org/about/Documents/DSM%20Member%20Acceptance%20Form.pdf

DSM-5 Task Force members’ bios and disclosures here: http://www.dsm5.org/MeetUs/Pages/TaskForceMembers.aspx

DSM-5 Work Group members’ bios and disclosures here: http://www.dsm5.org/MeetUs/Pages/WorkGroupMembers.aspx

(All 13 DSM-5 Work Group Chairs are members of the Task Force, which totals 29 members.)

A number of stories following publication of PLoS Medicine Essay by Linda Cosgrove and Sheldon Krimsky:

A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists

Full text available on PLoS site under “Open-access”

Or open PDF here

Citation: Cosgrove L, Krimsky S (2012) A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists. PLoS Med 9(3): e1001190. doi:10.1371/journal.pmed.1001190

Published: March 13, 2012

 

ABC News

DSM-5 Criticized for Financial Conflicts of Interest

Katie Moisse | March 13, 2012

Controversy continues to swell around the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, better known as DSM-5. A new study suggests the 900-page bible of mental health, scheduled for publication in May 2013, is ripe with financial conflicts of interest.

The manual, published by the American Psychiatric Association, details the diagnostic criteria for each and every psychiatric disorder, many of which have pharmacological treatments. After the 1994 release of DSM-4, the APA instituted a policy requiring expert advisors to disclose drug industry ties. But the move toward transparency did little to cut down on conflicts, with nearly 70 percent of DSM-5 task force members reporting financial relationships with pharmaceutical companies – up from 57 percent for DSM-4.

“Organizations like the APA have embraced transparency too quickly as the solution,” said Lisa Cosgrove, associate professor of clinical psychology at the University of Massachusetts-Boston and lead author of the study published today in the journal PLoS Medicine. “Our data show that transparency has not changed the dynamic.”…

Read on


New Scientist

Many authors of psychiatry bible have industry ties

Peter Aldhous | March 13, 2012

Just as many authors of the new psychiatry “bible” are tied to the drugs industry as those who worked on the previous version, a study has found, despite new transparency rules…

…”Transparency alone can’t mitigate bias,” says Lisa Cosgrove Havard University of Harvard University, who along with Sheldon Krimsky of Tufts University in Medford, Massachusetts, analysed the financial disclosures of 141 members of the “work groups” drafting the manual. They found that just as many contributors – 57 per cent – had links to industry as were found in a previous study of the authors of DSM-IV and an interim revision, published in 1994 and 2000 respectively.

Cosgrove also points out that the $10,000-per-year limit on payments excludes research grants. “Nothing has really changed,” she says…

Read on

Journal reference: PLoS Medicine, DOI: 10.1371/ journal.pmed.1001190

Please note that the petition launched in October by an ad hoc committee of the Society for Humanistic Psychology (Division 32 of the American Psychological Association) referred to in this article is intended for signing by mental health professionals.


Nature | News

Industry ties remain rife on panels for psychiatry manual
Review identifies potential conflicts of interest among those drawing up DSM-5.

Heidi Ledford | March 13, 2012

Potential conflicts of interest among the physicians charged with revising a key psychiatric manual have not declined despite changes to the rules on disclosing ties to industry, says a study published today1.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is used to diagnose patients, shape research projects and guide health-insurance claims. The fifth edition of the manual, DSM-5, currently being prepared by the American Psychiatric Association (APA) in Arlington, Virginia, is scheduled for publication in May 2013. But some of the suggested revisions are proving to be contentious. In particular, some psychiatrists worry that the broader diagnostic criteria for selected psychiatric conditions would encroach into the realm of the normal, thereby pathologizing ordinary behaviour and expanding the market for drug prescriptions (see ‘Diagnostics tome comes under fire’ and ‘Mental health guide accused of overreach’)…

Read on


From TIME Magazine:

TIME Magazine

What Counts As Crazy?

John Cloud | Online March 14, 2012

Print edition | March 19, 2012

…The mind, in our modern conception, is an array of circuits we can manipulate with chemicals to ease, if not cure, depression, anxiety and other disorders. Drugs like Prozac have transformed how we respond to mental illness. But while this revolution has reshaped treatments, it hasn’t done much to help us diagnose what’s wrong to begin with. Instead of ordering lab tests, psychiatrists usually have to size up people using subjective descriptions of the healthy vs. the afflicted.

…Which is why the revision of a single book is roiling the world of mental health, pitting psychiatrists against one another in bitter…

Full article available to subscribers


From last week’s New Scientist:

New Scientist

Should we rewrite the autism rule book?

Fred Volkmar and Francesca Happé | March 7, 2012
Magazine issue 2855.

AN EFFORT is under way to update the American Psychiatric Association’s diagnostic guide – the Diagnostic and Statistical Manual of Mental Disorders (DSM). In particular, changes suggested for diagnosis of autism are the focus of much debate.

There are clear reasons for changing and tweaking DSM categories and criteria in the light of new research, but the impact in this case is likely to be major…

Full article available to subscribers


Human Givens

International society removes ‘schizophrenia’ from its title

March 13, 2012

A statement from the ISPS today reveals that the society has voted to remove the word ‘schizophrenia’ from its title due to the term being deemed ‘unscientific and stigmatizing’:

“Members of the International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses ( www.isps.org ) have just voted, by an overwhelming majority, to change the society’s name to the International Society for Psychological and Social Approaches to Psychosis. The new logo and letterhead are to be adopted by the end of March…”

Read on

New Scientist, Prospect magazine and Allen Frances asks: Is Government Intervention Needed to Prevent an Unsafe DSM 5?

New Scientist and Prospect magazine on DSM-5; Allen Frances asks: Is Government Intervention Needed to Prevent an Unsafe DSM 5?

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Additional recent coverage of DSM-5 controversies:

Daily Mail

Michael Hanlon’s Science Blog | February 28, 2012

The Madness of American psychiatrists

DSM5 in Distress

Do We Need a DSM-V?
No, says an editorial from the Society of Biological Psychiatry

Allen J. Frances, M.D. | February 27, 2012

New Scientist print and online

New Scientist

There’s no sense in revising the psychiatrist’s bible

Online: Liz Else | February 22, 2012

Magazine issue 2853 (Subscription or paywall for access)

Print edition: Page 31 February 25, 2012

One minute with…Nick Craddock

There’s no sense in simply revising the psychiatrist’s diagnostic bible: it will need to be totally replaced to fit the emerging science…

Nick Craddock is professor of psychiatry at the Institute of Psychological Medicine and Clinical Neurosciences at Cardiff University School of Medicine, and is the director of the Welsh National Centre for Mental Health

Full version (Subscription required for online access)

Prospect Magazine

Issue 192, March 2012 (Subscription required for online access)

Mental disorder

By Anjana Ahuja
Anjana Ahuja is a freelance science journalist

In 1973, the American psychologist David Rosenhan sent eight healthy people, and also himself, to visit mental institutions and claim they were hearing voices. All were certified mad; some were incarcerated for a month. Rosenhan’s paper, “On Being Sane in Insane Places,” created a media sensation and a crisis in psychiatry. Doctors, it seemed, unlike suspicious fellow patients, could not tell a lucid stooge from a lunatic.

The ensuing controversy led to the tightening of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM), the “psychiatrists’ bible” that lists mental disorders and their symptoms. The DSM, first published in 1952, is produced by the American Psychiatric Association (APA), which, every decade or two, assembles a hundred or so mental health professionals to review disorders in the light of new science or shifting cultural norms…

Full version (Subscription required for online access)

Huffington Post

Allen Frances, MD | 02.24.12

Is Government Intervention Needed to Prevent an Unsafe DSM 5?

Donna Rockwell, Psy.D. was once a CNN reporter covering Capitol Hill. She is now a psychologist and a member of the petition committee calling for an independent scientific review of DSM 5. With her journalist’s instinct for the crux of any story, Dr. Rockwell has focused on increasing public scrutiny of DSM 5. She hopes to stimulate government intervention to ensure that DSM 5 meets its public trust. Dr Rockwell sent this email on Feb. 17:

You recently described the press as the one last hope to ensure that DSM 5 will be safe and sound. While I certainly agree that the press can do a great deal, there is an additional last hope you didn’t mention, one that could be even more powerful. Don’t discount the role of government intervention as a way of influencing the American Psychiatric Association.

I am currently networking on Capitol Hill and also with the Department of Defense and with the Veterans Administration. My goal is to increase awareness of the risks of DSM 5 and to recruit government assistance in forcing APA to abandon dangerous suggestions.

I tell government officials that DSM 5 will have a big impact on many important public health and public policy decisions that will directly affect their constituents. My short list includes: 1) raising the percentage of our citizens who are considered to be mentally ill — they are surprised to learn that it is already an astounding 50% lifetime; 2) increasing the cost of drug treatments and their harmful side effects; 3) pulling scarce mental health resources away from those who are really ill and most need them; 4) distorting benefit determinations for insurance, disability, compensation, and school services; and 5) creating great confusion in the courts.

The people I speak to all quickly understand the public health and public policy significance of DSM 5 and that government has a big stake in making it safe.

I am especially reaching out to the HELP (Health, Education, Labor & Pensions) committee chaired by Sen. Tom Harkin (D-IA), which oversees mental health issues and to Sen. Charles Grassley (R-IA), who has been very successful in holding doctors accountable. People in government are particularly concerned when I tell them that DSM 5 will have its worst impact on the most vulnerable populations — children, teenagers, and the elderly; veterans; and the severely mentally ill. I think the sentiment is growing that government intervention will be necessary to protect the public interest from the guild interests of the American Psychiatric Association and the economic interests of the drug companies.

I use concrete examples to get my points across. Most alarming, that DSM 5 will increase the already shameful overuse of antipsychotic drugs in kids and thus contribute to the dangerous epidemic of childhood obesity. DSM 5 will also greatly expand the diagnosis and medication treatment of ADD and indirectly facilitate the booming illegal market in prescription stimulants. DSM 5 will turn normal grief into depression. And DSM 5 will scare people into thinking they are on the road to dementia when all they have is the normal forgetfulness of aging. The Hill staffers I talk to all seem understand the risks of DSM 5 and I hope they will soon hold hearings. There is also considerable interest in the risks of DSM 5 at the VA and at DOD, where polypharmacy has been such a big problem.

The general public can help by calling or emailing congressional representatives to request protection from DSM 5. People should demand that DSM 5 be subjected to an outside, unbiased scientific review before accepting the controversial proposals that are getting so much negative press attention. I hope a legislative option can be forged in this battle to protect the nation’s mental health from the excesses of DSM 5.

I do wonder how loudly must the public and the professional mental health community shout, “Stop!”, before reason prevails. We need a government agency or elected official to take the lead in protecting the American people from the impending crisis of medicalised normality and excessive prescription drug use. The government must apply the brakes on DSM-5 before pharmacological over-kill impacts harmfully on even more people.”

As I read this, I find it both sad and silly that DSM 5 has allowed things to degenerate to the point where government intervention may indeed be necessary. DSM 5 has stubbornly ignored the general consensus that many of its suggestions simply make no sense and may cause grave damage both to public health and public policy. The DSM 5 hot potato suggestions should have been dropped long ago. They certainly must be rejected now.

Adding a new diagnoses in psychiatry can be far more dangerous than approving one of the new “me-too” drugs that so often come to market. It is paradoxical and nonsensical for us to carefully vet new drugs through a fairly rigorous FDA procedure but at the same time allow new diagnoses to be introduced through a badly flawed decision-making process completely controlled by just one professional organization that has lost its credibility. The new diagnoses suggested by DSM 5 will lead to widespread misdiagnosis and inappropriate drug use — causing far more damage than could possible be wrought by any new “me-too” drug.

To date, APA has failed to provide appropriate governance. DSM 5 has proven unable to govern itself, is not governed by APA, is not responsive to the heated opposition of mental health professionals and the public, and is insensitive to being shamed repeatedly by the world press. Government intervention may turn out to be the only hope to prevent massive misdiagnosis and all its harmful, unintended consequences.

Over 12,000 individuals and organizations have now signed the Coalition for DSM-5 Reform petition

Mental health professionals and mental health organizations can sign the petition here:

http://www.ipetitions.com/petition/dsm5/

For more information on the petition see: 

https://dxrevisionwatch.wordpress.com/coalition-for-dsm-5-reform/

or go to the petition website, here: Coalition for DSM-5 Reform website

http://dsm5-reform.com/

Please note the Coalition for DSM-5 Reform petition is intended for endorsement by mental health organizations and professional bodies and for signing by mental health professionalsnot intended for signing by patients.

Dx Revision Watch has no connection with the Coalition for DSM-5 Reform, its Open Letter initiative or associated petition. All enquiries relating to the Coalition for DSM-5 Reform should be addressed directly to Dr David Elkins, Ph.D., Chair, Coalition for DSM-5 Reform committee.

APA reschedules publication of DSM-5 draft proposals for diagnostic criteria

APA reschedules publication of DSM-5 draft proposals for diagnostic criteria

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Update: Some information here on Dr Todd Finnerty’s blog around the launch of the new DSM-5 website and publication of draft criteria: DSM-5 / DSM-V proposals will be ready, the website just needs to be tested

Draft proposals for the revision of DSM-5 diagnostic criteria are not now expected to be published until Wednesday 10 February.

In an announcement yesterday, 15 January, the APA noted on its website that “The new DSM5.org Web site, which will include proposed revisions and draft diagnostic criteria, has been rescheduled for launch on Wednesday, February 10, 2010.”

In Psychiatric News on 1 January 2010, Alan F. Schatzberg, MD, President of the American Psychiatric Association, had written that draft guidelines for diagnostic criteria would be posted on the Web on January 20 with a comment period of “two to three months” and that field trials would commence in July.

In a news release on 10 December, the APA announced that the timeline for the publication of DSM-5 (DSM-V) was being extended from May 2012 to May 2013.

WHO ICD Revision has its Alpha Draft for ICD-11 timelined for 10 May 2010 but has yet to announce a launch date for the iCAT – the wiki-like, collaborative authoring platform through which ICD-10 is being revised.

Read the APA’s 10 December News Release here 

Related material

Psychiatric News January 1, 2010
Volume 45 Number 1 Page 2
ASSOCIATION NEWS
by Jun Yan 

DSM-5 Postponed Until 2013; Field Trials Scheduled for Summer 

FROM THE PRESIDENT
Volume 45 Number 1 Page 3
by Alan F. Schatzberg, MD

Why is DSM-5 Being Delayed?

 

Previously on DSM-5 Watch

APA announces revised timeline for publication of DSM-5  3 January 2010

DSM-5: Revision controversies in New Scientist 3 January 2010

Christopher Lane on DSM revision and New Scientist article 4 January 2010

Christopher Lane on DSM revision and New Scientist article

Christopher Lane commentary on DSM revision and New Scientist article

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Update @ 9 January 10

On the Media | The Art of Diagnosis | 26 December 2008

Does very severe PMS constitute a mental disorder? That’s one of many questions facing psychiatrists as they work to revise the Diagnostic and Statistical Manual of Mental Disorders or DSM, the definitive compendium of our psychic maladies. Because the DSM influences not just doctors and patients but medical research, insurance companies, the pharmaceutical industry, advertising and the culture at large, controversy surrounding its new edition abounds. Brooke looks at this powerful book…

Audio and transcript: includes contributions from Christopher Lane, Brooke Gladstone, Dr Darrel Regier (Vice chair, DSM-5 Task Force), Dr Michael First and others.

Christopher Lane, PhD, is the Pearce Miller Research Professor at Northwestern University and author of Shyness: How Normal Behavior Became a Sickness.

On 12 December, Dr Lane published a commentary around the editorial and article published a couple of days before, by New Scientist:

Psychology Today

American Psychiatry Is Facing “Civil War” over Its Diagnostic Manual
What’s the real reason DSM-V has been delayed?

Yesterday, the American Psychiatric Association announced that it is pushing back the publication of DSM-V until 2013. The APA tried to put a good face on this rather embarrassing admission – embarrassing, because several spokespeople for the organization had insisted, quite recently, that they were on-track for publication in 2012 and that nothing would deter them…

Read full article here

On Friday, 18 December, Christopher Lane gave an interview on WNCY Radio, on the Brian Lehrer Show.  You can listen to the interview here:

The Brian Lehrer Show  |  18 December 2009  |  Mental Illness by the Book

http://www.wnyc.org/shows/bl/episodes/2009/12/18/segments/146466

http://www.wnyc.org/stream/ram?file=/bl/bl121809bpod.mp3

http://www.wnyc.org/flashplayer/player.html#/play/%2Fstream%2Fxspf%2F146466

“The Diagnostic and Statistical Manual of Mental Disorders, is commonly known as the “bible” of psychiatry. Christopher Lane, Northwestern University English literature professor and author of Shyness: How Normal Behavior Became a Sickness, discusses the controversy around revising this manual.”

Related information:

Previous commentary from Christopher Lane on the DSM revision process:

Los Angeles Times
Opinion
Wrangling over psychiatry’s bible
by Christopher Lane
16 November 2008

and

Slate
Bitterness, Compulsive Shopping, and Internet Addiction
The diagnostic madness of DSM-V
by Christopher Lane
24 July 2009

DSM-5: Revision controversies in New Scientist 09.12.09

DSM-5: Revision controversies in New Scientist 09.12.09

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Just one day before the American Psychiatric Association (APA) announced its intention to shift the publication date for DSM-5 one year on, to May 2103, New Scientist published an editorial and an article by Peter Aldhous [New Scientist’s San Francisco bureau chief] on the controversies around the revision of DSM-IV:

New Scientist

Editorial:
Time’s up for psychiatry’s bible
09 December 2009

“…The final wording of the new manual will have worldwide significance. DSM is considered the bible of psychiatry, and if the APA broadens the diagnostic criteria for conditions such as schizophrenia and depression, millions more people could be placed on powerful drugs, some of which have serious side effects. Similarly, newly defined mental illnesses that deem certain individuals a danger to society could be used to justify locking these people up for life…”

Read full editorial here

Article:
Psychiatry’s civil war
by Peter Aldhous
09 December 2009

“…Two eminent retired psychiatrists are warning that the revision process is fatally flawed.* They say the new manual, to be known as DSM-V, will extend definitions of mental illnesses so broadly that tens of millions of people will be given unnecessary and risky drugs. Leaders of the American Psychiatric Association (APA), which publishes the manual, have shot back, accusing the pair of being motivated by their own financial interests – a charge they deny. The row is set to come to a head next month when the proposed changes will be published online. For a profession that exists to soothe human troubles, it’s incendiary stuff.”

“…Some of the most acrimonious arguments stem from worries about the pharmaceutical industry’s influence over psychiatry. This has led to the spotlight being turned on the financial ties of those in charge of revising the manual, and has made any diagnostic changes that could expand the use of drugs especially controversial.”

Read full article here

*See: Letter to APA Board of Trustees July 7 2009 From Allen Frances and Robert Spitzer 06 July 2009

See also:

Psychiatric Times
News
A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences
Allen Frances, MD
26 June 2009

Dr Frances was chair of the DSM-IV Task Force

 

See: Psychiatric Times DSM-V Resource page for further commentaries by Spitzer, Frances and others and responses from APA board officials

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